I know that there used to be several services out there where, for a
fee, they would research a medical condition and assemble the various
alternative treatments and/or top physicans in the field. One of them
to my recollection charged something in the order of $500.

I need some help in finding these services.  I'm looking for services
that are in the ongoing business of providing such medical consulting.

This is for my sister who has just been diagnosed with a herniated
disc.  I want to make sure that I collect a summary of the various
treament options, their strengths and weaknesses, and who are the
leading clinics and the leading physicians in this subject area (but I
really want to get this from someone in the business of doing this
specific type of information service).

Just to make clear, I am not looking for the answer... I'm looking for
places to get the answer... places the charge money for providing the
answer.  But I would like an exhausitve list of those places.

---

Request for Question Clarification by pafalafa-ga on 09 Mar 2004 17:41 PST

There is a list of "Ask the Doctor" type services (many of them
fee-based) that you can find here:

http://directory.google.com/Top/Reference/Ask_an_Expert/Medicine_and_Health/

They're not quite what you're looking for, but I haven't yet come
across the type of service you've described.  Anything comes up,
though, I'll be sure to let you know.

I've had some back problems myself.  My sympathies to your sister, and
the best of luck.

Unfortunately I have have no way of evaluating the quality of the
services that I am seeking.  So I need to start somewhere.  And
finding an establishment that has a website dedicated to this
particular type of service... with employees is another (imperfect)
way of finding a reliable source of information.

The source not only needs to be credible, but needs to appear to be
credible to my sister... or she will not use the information she gets.
 in this case, credentials and appearances are just as important as
substance... perhaps more so.

Any recomendations on how to elicit more of a response to this query?

Dear CESCES,

I do not have the answer you seek at this time however, I can tell you
that the best place to begin is your family physician.  You can also
try WebMD for information.  ANY source you find will be biased towards
their field.  Check out WWW.consumerreports.org for a review of
chiropractic.  They should be non-biased.

ASSUMING the diagnosis is correct a good neuro/spinal surgeon will not
operate on her unless she has had her pain for 6 months minimum.  This
is because most disks repair themselves in 6 weeks to 6 months.  LOSS
OF BOWEL OR BLADDER CONTROL IS AN EMERGENCY.  Dr. Jeffery Saal had a
very good paper called "Dynamic muscular stabalization of the lumber
spine" showing his specific exericise program was at lease as
effective as surgery.  Here is a website discussing a newer technique
of his (of which I know nothing):
http://www.esculape.com/rhumato/idet.html

A physiotherapist from New Zealand named McKenzie has a good self help
book where he teaches his so called "McKenzie Position", a position
which reduces the pain temporarily (as a rescue).  The McKenzie
position involves lying on the stomach and propping yourself up on
your elbows.  This puts the lumbar spine into a more lordotic position
and puts pressure on the disk in a way which should minimize posterior
herniation (towards the nerve root).

A very important principle is to avoid permanent pain by being as
active as you reasonably can be.  The prevents weakness and tightness
of the back muscles while perhaps minimizing scarring around the
inflammed herniated disk pulp and impinged nerve root.  Restricted
duties and an early return to work is beneficial if possible.

Anti-inflammitory medication probably have no benefit beyone three
weeks.  Narcotics are sometimes needed but can lead to sensitization
to pain and a subsequent increase in pain as well as dependency. 
Amitriptyline and Gabapentin have been useful for the burning nerve
irritation if present.

Take away message: See your family physician as the ideal starting
point.  BEWARE OF CON-ARTISTS WHO WILL TAKE ADVANTAGE OF PEOPLE IN
PAIN.  If it sounds to good to be true...it is.

PS. Beware of red flags, such as: fever, escalating pain, pulsatile
pain, abdominal pain, loss of bowel or bladder control, a rash in the
distribution of the leg pain (shingles), rectal bleeding, night sweats
or unexpected weight loss (these are off the top of my head - see your
doctor if anything strange is happening).

Vital Science & Health is a custom research firm expert in information
pertaining to medicine, health care, and the life sciences. Searching
by its name in Google will bring you there.  reb-ga

I do not know of any research groups that currently provide
comprehensive information covering all disciplines of medicine, and I
have been in this field for 17 years.  It is still very fragmented. 
However, here are some very good resources to go to and are reputable
(my sister has gone thru the same things recently)...
emergingworlds.com is a site that is dedicated to multi forums of
physicians, researchers, clinicians, scientists, advocates, and
patients in health issues.  Their focus is on degenerative diseases,
and they are always very responsive to any inquiries.  They have a
multi-disciplinary team which means their research and information
includes "complementary medicine", "conservative medicine",
conventional medicine, native american indian medicine, alternative
medicine, and homeopathic, as well as all forms of therapeutic
technology (ancient to cutting edge).  Most important is that they
have open access for contact / discussions with other patients from
around the world with similar experiences.  There is another site
which you can find at www.ccid.org.  The site is primarily dedicated
to degenerative diseases that are related to stealth viruses, however,
they have more relations and information on all forms of degenerative
disease / disorders than most groups out there, plus faculty that is
fully comprehensive from physicians, surgeons, psychiatry, psychology,
boiophysics, oncology, orthopedics, pathology, etc.  The staffing is
expert, with credentials all the way back to directorships within the
National Health Institute.  Again, multi-disciplinary in its approach.
 My last suggestion is to check with www.blochcancer.org, which is the
site for a group by the name of R.A. Bloch Cancer Foundation, Inc. 
The group was founded by Richard A. Bloch of H.R. & Bloch (the tax
people).  Richard Bloch went thru MD Anderson many years ago when
interferon was new experimental treatment for cancer, with progressed
cancer of his own ... his experience was so horriffic that upon
recovery, he left and founded the RA Bloch Cancer Center in Kansas
City.  The purpose (and it still is) was to provide anyone who had
been diagnosed with cancer the ability to acquire a multi-disciplinary
"second opinion".  This "opinion" was based off of the patients'
medical records to that point, new diagnostics done at the center, and
performed by a 30 memeber physicians' panel comprised of all medicine
disciplines (Bloch has been a major advocate in Washington DC and
throughout the world in teaching that "alterntive" is not a "dirty
word".), who would then put forward a determined treatment plan, and
resource referral.  All of this was for the cost of $500 ....  Now, it
is a service designed for cancer diagnosis and not spinal ... But, if
anyone would know, where a comprable service could be found for spinal
conditions, they would.  They are wonderfully warm people and Richard
and his wife have kept themselves very personally involved over the
years (his initial treatment was back in the late 70's ... we met then
(I was going thru care myself) and he personally referred my mother in
for diagnostics and treatment to MD Anderson a few years later (1982)
when her primary physician (who had failed to properly diagnose her
condition which led to her heart attack at work from which her
hospitalization by ambulance for that led to the discovery of it
having been caused by a lung tumor so large it had compressed a major
artery causing the "attack" ... which he had attended to her pulmonary
care for the previous 20 months of constant complaints, etc., and had
sent her off for xrays and such, but upon later examination of the
charts had never "read" the xrays and charted her condition as
"psycho-sematic" due to "stress" ... and such he didn't want to do the
referral to Anderson, which to attend there you must be referred by a
physician ... so, Bloch assisted, and has continued to "help" through
the years with referrals one at a time, one on one.  I highly suggest
speaking with them...  As my last comment, there is a fairly "new"
treatment that has had wonderful results with spinal injuries.  It is
non-invasive and has been approved in the U.S. for use in physicians
offices, however, due to the cost of "FDA lables" in this country, it
is still going through the process for approval in hospitals and
institutions.  Due to multiple physicians being able to utilize the
therapy, you may find various quality of websites (some have
questionable appearance in so far as the "design" quality of the page,
but if you go to yahoo (excuse me google or google)and search the term
papimi or PAP IMI (which is the proper form of the term)you will find
great detail on the therapy.  I not only advocate it (but be sure to
use experienced physicians or therapist in its applications, look up
the paitent testimonials and ask them who they went to for therapy ...
you didn't say what part of the country you are in geographically so I
don't know who to refer you to ... we have relations with some people
in California, Texas, Ill, and NY ....  but it is real.  I advocated
and supported the research and protocol studies and device
certifications here in the US for this therapy, after years of
detailed research (I work with a nonprofit and we have worked with
faculty at New York Med, and the Stoneybrook Research Institute among
others in claims substantiation and in-vetro testing, research etc, in
multiple medical issues over the years) ... I watched people recover
from multiple health issues, and even watched paralysis revers...
(spinal regeneration is one of the primary applications for the
therapy)... However, I have also used the therapy myself.  In 1975 I
was in coma from July thru Sept as a result of ARDS (still unknown in
its origins, but 6 hours before my respritory failure I had been
"nipped" by a sick seal in a sea mammal rescue thing, and the seal
died about 30 hours later as I lay "dying" in ICU and unconscious...
Anyway, my wonderful physician who thumped his nose at various
collegues and did some unconventional things to keep me alive and get
me well, along with 3 dedicated children who tended me (very young
without the hassels of "adult" life to make it "encumbersome")... I
survived ... multiple health issues never before experienced began
manifesting after recovery of the ARDS... until 2 yers ago I had
another pulmonary collapse (3 months in the hospital, and my wonderful
physican staying by my bedside overnight and for hours at a time in
efforts to not vent me, was present when Dr. Papgos (who is a nobel
prize winner in energy sciences ... and the "co-inventor" of the PAP
IMI therapy, and some others came to visit me ...  their combined
concerns resulted in my being given therapy from the PAP IMI, and my
clincial condition went from not being able to speak from the lack of
being able to breathe even on mass oxygen ... to being able to speak
clearly and my blood oxygen increased from 78 -82 to 93% (without ox)
within 20 minutes of therapy ...  It was an interesting situation to
be on the receiving end of a therapy I had advocated from a
"research", clinical trial, and evaluation position.  The reason it is
effective in multiple health issues is that it is energy medicine and
"directs" itself with proper application, to the "failing" / "dying" /
"impaired" and / or diseased / degnerative cells in the body ... 
Thus, many times specific to the type spinal damage in profile, with
regards to your sister's situation, the "injury" , damage, is such
that surgery is a suggested route because "cells" appear "dead" or
"non-repairable" ...  etc. to conventional medicine and through common
diagnostics ...  However, although the "energy level of the cell" may
be non-functioning in a generally "measurable" way, if there is "life"
(energy) in the cell(s) at all PAP IMI will be effective.  It is
important to have proper medical / clinical advice in its use... It
can increase the effects of medicines / drugs / herbal compounds etc.,
that someone may be using and should not be simply utilized because it
works ...  But, it does work.  In most cases, permenant effects (not
just reactive) with long term corrective / restorative results come
about after 3 to 6 months of therapy that has multiple sessions per
week.  It is again, something to do with a clinician or physician's
direction.  Most often the progess needs to increase in frequency and
not just "jumped into all at once".  Papagos is from Greece and not a
physician so he cannot conduct treatment but is generally available
for discussion ...  Because of the positive impact that so many have
experienced with this therapy (and it being non-invasive), many groups
(such as our friends in Texas) will travel to people who need help if
there is not a PAPIMI unit within geographical access.  In fact,
almost anyone who has used PAPIMI will do the same, because it is
life-changing to come out the "other side", from pain, paralysis,
terminal illness, chronic and "uncurable" conditions, etc.... and
there is simply a moral struggle to not avail yourself however you can
to someone else in need ...  (much like Bloch did in his way ... not
all of us are the "R" in a situation like HR & Bloch though ... so
sometimes it is a bit of a grass-roots type support system) ...  I
realize I have written a great deal of commentary, however, I do know
how wrenching it is to try to access resources of sufficient depth to
feel as though you are making an informed decision. God Bless